Total Knee Replacement Surgery FAQs

Knee Replacement

What is the recovery time for total knee replacement surgery?

Everyone heals from total knee replacement surgery at a different pace. In most cases, however, you will likely use a walker or crutches for 2 to 4 weeks after your operation. You will then advance to a cane and wean to no assistive device at all. You will gradually return to normal function without any assistive devices. In general, most patients are close to full recovery after 3 months.

When do my stitches or staples come out after total knee replacement surgery?

Your surgeon may close your wound in a variety of ways.

If you have staples, they should be removed 2 weeks post-operatively. This will be done by a visiting nurse, home physical therapist, or at a rehabilitation facility if you are not at home.

If you have stitches, they are absorbable and do not need to be removed. The steri-strips that have been applied can be kept in place until they fall off on their own. They will help keep the skin edges together. If they have not fallen off by 2 weeks, it is OK to peel them off. Some wounds have a tail of suture that is visible at each end of the incision. You may trim this level with the skin at 2 weeks.

How long do I need a bandage after total knee replacement surgery?

You need a bandage for approximately 1 week or until the wound is dry. This bandage should be changed daily to a new dry, sterile gauze. If desired, you may continue to wear a bandage to protect the incision from irritation.

When can I shower (get incision wet) after total knee replacement surgery?

You may shower 3 days after your operation. If no drainage is present at the incision, no protection of the wound is required. If there is drainage from the incision, try to keep it covered and dry while showering.

When can I immerse my knee in water (e.g., bath, swimming pool, ocean, hot tub) after total knee replacement surgery?

You may immerse your knee in water after 4 weeks, if there is no drainage from the incision. The incision must be healed before it is immersed in water.

How long will I be on pain medication after total knee replacement surgery?

You will likely require some form of pain medication after your hospital stay. Initially, you will be on a strong oral pain medication (such as a narcotic). Most people are able to wean off of their strong pain medication after 1 month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), Plavix, or other blood thinner, avoid taking any NSAIDs (e.g., aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting your internist.

How long will I be in the hospital after total knee replacement surgery?

The length of time spent in the hospital varies from patient to patient. Average length of stay for a total knee replacement is 3 to 4 days.

Will I go to rehabilitation or home after total knee replacement surgery?

It depends. Many people are able to go home after their operation. However, you may go to a rehabilitation hospital in order to gain the skills you need to safely return home. Many factors will be considered in this decision. These include availability of family or friends to assist with daily activities, home environment, safety considerations, post-operative functional status as evaluated by a physical therapist in the hospital, and overall evaluation by your hospital team.

Do I need physical therapy after total knee replacement surgery?

Yes! The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually 2-3 times a week). Sometimes, you will be referred to an outpatient physical therapist. If you go to a rehabilitation hospital, you will receive therapy there. Your therapist will help you walk, regain motion, build strength, and reach your post-operative goals. Your therapist will keep your surgeon informed of your progress.

Do I need a CPM (continuous passive motion) machine after total knee replacement surgery?

You will likely use a CPM machine in the hospital. You will not need a CPM machine after you are discharged from the hospital.

What exercises should I do after total knee replacement surgery?

You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and a stationary bicycle are good exercise options. Regular conditioning and exercise should be continued indefinitely, even after your recovery is complete.

What equipment do I need at home after total knee replacement surgery?

Your home equipment needs will be addressed by your therapist and social worker at the hospital. Most equipment will be ordered and delivered to your home before you are discharged. Typical equipment will include a walker or crutches. No CPM or hospital bed is needed.

What are good positions for my knee? What positions should I avoid?

You should spend some time each day working on straightening your knee (extension) as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you are lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or towel roll behind the knee for any length of time.

Can I use weights after total knee replacement surgery?

Generally, you should not use weights for the first 2 months after total knee replacement surgery. However, as everyone's strength varies, consult with your physical therapist before using weights. Use light weights to begin with (1 to 5 lbs.) and gradually progress. No squats, lunges, or leg presses. Avoid exercises that cause significant discomfort or pain.

How long will I be on a “blood thinner” after total knee replacement surgery?

Typically, you will be on a blood thinner up to 1 month. The exact type and duration will be determined by your physician based on your specific medical history and risk. Of note, if you are on Coumadin (warfarin), it is extremely important to have your blood thinner level checked regularly and your Coumadin dose adjusted accordingly.

Should I take iron supplements after total knee replacement surgery?

Iron supplements help your body replenish its iron stores and blood count, which may be depleted post-operatively. You may take an over-the-counter iron supplement or a multivitamin with iron for this purpose. Please note that iron may contribute to constipation and also darken the stool.

I am constipated after total knee replacement surgery. What should I do?

It is very common to have constipation post-operatively. This may be due to a variety of factors, but it is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or enema.

When can I drive after total knee replacement surgery?

If you had surgery on your right knee, you should not drive for at least 1 month. After 1 month, you may return to driving as you feel comfortable. If you had surgery on your left knee, you may return to driving when you feel comfortable as long as you have an automatic transmission. DO NOT DRIVE IF TAKING NARCOTICS. Most important, do not take chances, and only resume driving if you are confident in yourself. It is recommended that you test your driving ability prior to driving in traffic.

When can I return to work after total knee replacement surgery?

When you can return to work after total knee replacement surgery depends on your profession. If your work is sedentary, you may return as early as 2 to 4 weeks post-operatively. If your work is more rigorous, you may require up to 3 months before you can return to full duty. In some cases, more time may be necessary.

When can I travel after total knee replacement surgery?

You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots. Long flights or car rides may increase the risk of a blood clot. Use of a blood thinner such as aspirin may be indicated.

Will I set off the machines at airport security after total knee replacement surgery? Do I need a doctor’s note about my surgery?

You may set off the machines at airport security, depending on the type of hip implant you have and the sensitivity of the security checkpoint equipment. A wallet card or letter is not helpful or required to travel.

What activities are permitted following total knee replacement surgery?

You may return to most activities as tolerated, including walking, gardening, and golf. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle.

What activities should I avoid after total knee replacement surgery?

You should avoid impact activities, such as running and downhill skiing, and vigorous racquet sports, such as singles tennis or squash.

Can I have sex after total knee replacement surgery?

You may resume sexual activity when you feel comfortable.

Can I drink alcohol after total knee replacement surgery?

If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should also avoid alcohol if you are taking narcotics or other medications.

Should I wear compression stockings (TEDS) after total knee replacement surgery?

Compression stockings are not required post-operatively.

Should I use ice or heat after total knee replacement surgery?

Ice can be used for the first several days, particularly if you have a lot of swelling or discomfort. Once the initial swelling has decreased, you may use ice and/or heat.

Can I kneel after total knee replacement surgery?

After 2 months, you may try to kneel. Although this may be uncomfortable initially, you will not injure your knee replacement by kneeling. Most people find the more you kneel, the easier it gets.

Can I go up and down stairs after total knee replacement surgery?

Yes. Initially, you will lead with your non-operated leg when going up stairs and lead with your operated leg when going down stairs. You can use the phrase, "Up with the good, down with bad" to help you remember. As your leg gets stronger (after about 1 month), you will be able to perform on stairs in a more regular pattern.

How much range of motion (ROM) do I need after total knee replacement surgery?

Most people require 70° of flexion (bending the knee) to walk on level ground, 90° to ascend stairs, 100° to descend stairs, and 105° to get out of a low chair. Your knee should also come to within 10° of being fully straight to function well.

What should I expect for my range of motion (ROM) after total knee replacement surgery?

Everyone's range of motion (ROM) varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have at least 90° of flexion by 4 to 6 weeks. Typically, ROM continues to improve with continued physical therapy. If your ROM is poor (less than 70° of flexion as you approach 4 weeks post-op), please call to notify your surgeon.

I think my leg feels longer after total knee replacement surgery. Is this possible?

In the large majority of cases, leg length is essentially unchanged after total knee replacement surgery. In rare cases, however, you may notice a change in leg length. This is more common when a severe deformity of the knee exists before surgery. At first, this may feel awkward. However, you will gradually become accustomed to your new knee and leg length.

Do I need antibiotics before dental work or an invasive procedure after total knee replacement surgery?

Yes. Please refer to the antibiotic prophylaxis recommendation sheet given to you. Avoid any dental cleaning or non-urgent procedures for 6 weeks post-operatively.

Do I need antibiotics when I get ill after total knee replacement surgery?

Typically, you do not need antibiotics for illnesses such as a cold or flu. These are caused by viruses. However, if you have a bacterial infection (such as strep throat), you should be placed on an antibiotic by your primary physician. This helps prevent infection from traveling to your joint replacement.

I feel depressed after total knee replacement surgery. Is this normal?

It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.

I have insomnia after total knee replacement surgery. Is this normal? What can I do about it?

Insomnia is a common complaint following total knee replacement surgery. Non-prescription remedies such as Benadryl or melatonin may be effective. If insomnia continues to be a problem, medication may be prescribed for you.

How long will my total knee replacement last?

This varies from patient to patient. Over 90% of knee replacements will be functioning well at 10 to 15 years post-op. With continued improvements in knee replacement technology, your new knee may last well beyond this.

When do I need to follow-up with my surgeon?

A follow-up appointment should be made post-operatively at 4-6 weeks, then at your surgeon's discretion. Routine follow-up of your joint replacement will be scheduled over the lifetime of your replacement.

Who should I call with questions after total knee replacement surgery?

In the case of an emergency, call 911. For all other inquiries, call the office at 404-778-3350. After business hours, listen to the recording and follow the instructions. Calls will be returned as soon as possible.

Normal things about your new knee:

Abnormal things about your new knee (call the office immediately if you experience any of these):

Clicking noise with knee motion

Skin numbness on the outer (lateral) part of your knee

Swelling around knee and/or lower leg

Warmth around knee

"Pins and needles" feeling at or near incision

Dark or red incision line. This will gradually fade to a lighter color.

Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt

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